Evidence of pial synagiosis through ventriculoperitoneal shunt entry site in a patient who manifested Moyamoya syndrome later in childhood: A case report and historical perspective.

The term Moyamoya , or "puff of smoke" in Japanese , was first used in 1969 by Suzuki and Takaku to describe the classical appearance of collateral blood vessels in response to progressive vascular stenosis of distal internal carotid artery (ICA). Such condition may result in various clinical presentations ranging from strokes to developmental delays. In order to cease the progression of such stenotic vasculopathy, several means of revascularization have been developed over the years. In this paper we present a case of a two-year-old girl with history of myelomeningocele repair and ventriculoperitoneal shunt insertion followed by manifestation of Moyamoya syndrome later in childhood as an evidence of revascularization through a burr hole. To our knowledge, this paper is the first of its kind to report such findings in one patient. Moreover, this paper provides a historical perspective on the development of different types of revascularization techniques.

Barriers to Accessing Neurosurgical Services: A Cross-Sectional Study of Public and Patient Perspectives in Saudi Arabia.

INTRODUCTION: Neurosurgical care is paramount for addressing various neurological conditions. However, several factors may hinder individuals from accessing these services. This study aimed to identify the factors that deter Saudi citizens from receiving neurosurgical care, emphasizing perceived barriers and sociodemographic influences. METHODS: Utilizing a cross-sectional research design, this study surveyed 1,795 participants from five distinct regions in Saudi Arabia, capturing a wide demographic range including age, gender, education, occupation, and residence. Stratified random sampling was adopted to ensure representation across different socioeconomic backgrounds. Data was collected using structured online questionnaires in both Arabic and English, which assessed demographic characteristics, patient experiences, perceived barriers, and satisfaction related to neurosurgical services. RESULTS: The majority of the participants (79.6%) reported never accessing neurosurgical services, and 28.8% indicated difficulties in accessing them. Most participants expressed neutral feelings (38.1%) or satisfaction (23.4%) with neurosurgical service accessibility, though a significant minority expressed dissatisfaction (9.0%) or strong dissatisfaction (4.3%). Concerning factors for selecting neurological services, the expertise and reputation of healthcare professionals were paramount, while cost and proximity were lesser concerns. Significant perceived barriers included financial constraints and prolonged appointment waiting times. Results also revealed a relationship between sociodemographic characteristics and perceived barriers: females, certain age groups (25 to 34 and above 65), those with higher education levels, retired individuals, and residents of the Northern Province and urban areas reported higher perceived barriers. Regression analysis identified gender, education level, employment status, and residency as significant predictors of perceived barriers. CONCLUSION: This study underscores the prominent barriers faced by Saudi citizens in accessing neurosurgical care, with financial constraints and waiting times being paramount. Additionally, sociodemographic factors play a crucial role in the perception of these barriers. As healthcare disparities persist, targeted interventions, policy reforms, and educational campaigns are essential to bridge the gap and ensure equitable neurosurgical care access across all demographic segments in Saudi Arabia.

Large skull osteoblastoma presented as aneurysmal bone cyst (ABC).

Aneurysmal bone cysts (ABCs) are rare benign vascular bony lesions mostly encountered in young patients. These cysts can occur as primary lesions or, less frequently, secondary to other pathologies such as osteoblastomas. Skull ABCs are rare and can extend intracranially, presenting with hydrocephalus and bleeding. Here we illustrate the case of a 9-year-old male who presented with headache, nausea, and vomiting, without neurological deficit. Radiological investigations showed a soap-bubble lesion with mass effect over the right cerebellum. The patient underwent right sub-occipital craniotomy with marginal wide resection of the cystic lesion. The patient had excellent outcomes. The histopathological report was consistent with osteoblastoma with an aneurysmal bone cyst.